Provider Demographics
NPI:1992148423
Name:AJIBADE, ALAAFIA O (MA, PD)
Entity type:Individual
Prefix:
First Name:ALAAFIA
Middle Name:O
Last Name:AJIBADE
Suffix:
Gender:M
Credentials:MA, PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HUDSON ST
Mailing Address - Street 2:APT. B
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2803
Mailing Address - Country:US
Mailing Address - Phone:732-423-0708
Mailing Address - Fax:
Practice Address - Street 1:15 HUDSON ST
Practice Address - Street 2:APT. B
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:732-423-0708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ851495103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool